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Background <p>To examine the effects and interaction of contralesional plantar peripheral electrical stimulation (PES) and posterior parietal cortex transcranial magnetic stimulation (PPC-TMS) on lower-limb motor function, balance, activities of daily living, and gait variables in patients with subacute post-stroke hemiparesis.</p> Methods <p>This study used a prospective, randomized, double-blind 2 × 2 factorial trial design. A total of 151 patients with post-stroke hemiparesis (2 weeks to 6 months after onset) were enrolled and randomly assigned (1:1:1:1) to a double-sham control group, real PES group, real PPC-TMS group, or combined intervention group. All groups received the assigned intervention in addition to conventional rehabilitation: real PES was delivered to the plantar surface of the contralesional, non-paretic foot (i.e., the foot opposite to the paretic lower limb); real PPC-TMS targeted the contralesional posterior parietal cortex using an intermittent theta-burst stimulation (iTBS) protocol, 5 sessions/week for 4 weeks. The primary outcome was the post-intervention Fugl–Meyer Assessment for the Lower Extremity (FMA-LE) score (analyzed using a 2 × 2 factorial model with baseline FMA-LE as a covariate). Secondary outcomes included the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), lower-limb–related Modified Barthel Index (MBI), and three-dimensional gait parameters.</p> Results <p>Baseline characteristics were comparable among the four groups. After the intervention, FMA-LE scores were 19.40 ± 3.21, 21.00 ± 3.10, 21.12 ± 3.16, and 25.60 ± 2.80, respectively. Compared with the control group, the real PES group, real PPC-TMS group, and combined group showed higher post-intervention FMA-LE scores by 1.60, 1.70, and 6.20 points, respectively (all <i>P</i> &lt; 0.05). In the baseline-adjusted factorial model, the PES×PPC-TMS interaction was significant (<i>P</i> = 0.004). Regarding secondary outcomes, PASS, BBS, and lower-limb MBI improved versus control, with the combined group demonstrating the greatest overall gains. Three-dimensional gait analysis showed improvements in parameters including hip flexion, knee flexion, pelvic angles, and ankle joint angles, with evidence of interaction effects.</p> Conclusion <p>Contralesional plantar PES combined with contralesional PPC-TMS significantly enhances lower-limb motor recovery of the affected side in patients with subacute post-stroke hemiparesis. The combined intervention exhibits synergistic benefits, providing preliminary clinical evidence supporting a “contralesional dual-pathway” stimulation strategy.</p>

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Contralesional plantar peripheral electrical stimulation combined with contralesional posterior parietal cortex repetitive transcranial magnetic stimulation promotes lower-limb motor recovery in stroke patients with hemiparesis: a randomized, double-blind, factorial controlled trial

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  • 发表日期：

    2026年7月28日

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  • Yide Wang,
  • Rong Bian,
  • Siming Tao,
  • Qianqian Liang,
  • Yanqian Wang,
  • Yu Li,
  • Henghui Chen,
  • Shuyu Li,
  • Qianqian Xue,
  • Tuerxunayi Kahar

摘要

Background

To examine the effects and interaction of contralesional plantar peripheral electrical stimulation (PES) and posterior parietal cortex transcranial magnetic stimulation (PPC-TMS) on lower-limb motor function, balance, activities of daily living, and gait variables in patients with subacute post-stroke hemiparesis.

Methods

This study used a prospective, randomized, double-blind 2 × 2 factorial trial design. A total of 151 patients with post-stroke hemiparesis (2 weeks to 6 months after onset) were enrolled and randomly assigned (1:1:1:1) to a double-sham control group, real PES group, real PPC-TMS group, or combined intervention group. All groups received the assigned intervention in addition to conventional rehabilitation: real PES was delivered to the plantar surface of the contralesional, non-paretic foot (i.e., the foot opposite to the paretic lower limb); real PPC-TMS targeted the contralesional posterior parietal cortex using an intermittent theta-burst stimulation (iTBS) protocol, 5 sessions/week for 4 weeks. The primary outcome was the post-intervention Fugl–Meyer Assessment for the Lower Extremity (FMA-LE) score (analyzed using a 2 × 2 factorial model with baseline FMA-LE as a covariate). Secondary outcomes included the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), lower-limb–related Modified Barthel Index (MBI), and three-dimensional gait parameters.

Results

Baseline characteristics were comparable among the four groups. After the intervention, FMA-LE scores were 19.40 ± 3.21, 21.00 ± 3.10, 21.12 ± 3.16, and 25.60 ± 2.80, respectively. Compared with the control group, the real PES group, real PPC-TMS group, and combined group showed higher post-intervention FMA-LE scores by 1.60, 1.70, and 6.20 points, respectively (all P < 0.05). In the baseline-adjusted factorial model, the PES×PPC-TMS interaction was significant (P = 0.004). Regarding secondary outcomes, PASS, BBS, and lower-limb MBI improved versus control, with the combined group demonstrating the greatest overall gains. Three-dimensional gait analysis showed improvements in parameters including hip flexion, knee flexion, pelvic angles, and ankle joint angles, with evidence of interaction effects.

Conclusion

Contralesional plantar PES combined with contralesional PPC-TMS significantly enhances lower-limb motor recovery of the affected side in patients with subacute post-stroke hemiparesis. The combined intervention exhibits synergistic benefits, providing preliminary clinical evidence supporting a “contralesional dual-pathway” stimulation strategy.